San Francisco health officials over the years have turned to cartoon characters in order to relay important health messages to men who have sex with men in attention grabbing ways.

Most famously, the city's health department in 2002 launched the Healthy Penis, an anthropomorphic phallus character, in order to promote regular testing for the sexually transmitted disease syphilis. The at-first controversial campaign proved successful and spawned several penis characters representing different ethnicities and their nemesis, Phil the Syphilis sore.

The latest fictional figure to promote a sexual health message aimed at gay and bisexual men comes from the San Francisco AIDS Foundation. This time it is a blue douche bottle that at times dons eyeglasses or is adorned in a doctor's white smock and stethoscope.

Dubbed Douchie McDoucherson, and preferring gender-neutral pronouns, they were first introduced in early 2017 as a way to educate men on the proper way to anally douche. The character also encourages men to bring up anal health issues with their health care providers.

"Douchie brings butt health and happiness out of the closet so you can care for your butt in the way it deserves," explained the agency in a March 2017 post on its Beta blog.

This summer the nonprofit ramped up usage of Douchie in posters and online to continue to spread a message of proper anal health. A banner featuring Douchie decked out in a harness will soon be displayed in the entrance of Strut, the men's health clinic SFAF operates in the heart of the Castro.

"There is no anal douching school you go to," said Pierre-Cedríc Crouch, head of nursing at SFAF and its Magnet clinic housed at Strut.

Crouch worked with Emily Land, a content marketing manager for SFAF and editor in chief of its Beta blog, on the initial content regarding proper anal health. The information informed the creation of the douche character, which was first designed by Laura Donnell, now the director of design at EvoShare.

Roxane Chicoine, SFAF's creative director, has created the iteration of the character for this summer's campaign. One poster released this year features Douchie promoting a number of butt health tips.

When it comes to douching, the poster advises men "to go easy" and only use water or saline at room temperature. It is best to limit douching to once a day, adds Douchie, and no more than two to three times a week.

"A lot of people do it but don't talk about it," said Land in an interview this week with the Bay Area Reporter at Strut to talk about the campaign.

Most people douche "in secret," noted Crouch, and may be embarrassed to talk to their doctor about issues they are experiencing with their anus. Having the posters featuring Douchie in the exam rooms at Strut has encouraged patients to broach the subject, he added.

"We want guys to start to talk about it and open up the conversation that people weren't having," said Crouch.

It is important to ensure men have the right information about how to douche because, if done improperly or with the wrong equipment, it can have adverse health effects, said Crouch.

"Sometimes people can hurt themselves," he said, leading to anal fissures that are painful, but treatable, and can put a person at risk for acquiring HIV.

Or they use the wrong fluids, like vinegar, bleach, or hydrogen peroxide, to douche with, falsely thinking it will function as a disinfectant against STDs.

"People will use all different fluids. They think if they put chemicals in there it will kill off everything," said Crouch. "People are also using coke bottles or all sorts of weird, little things to douche with."

While douching has not been shown to spread STDs, said Crouch, it does not protect someone from acquiring sexually transmitted infections like syphilis, gonorrhea, and chlamydia. The main reason most men douche is to have a more enjoyable experience being the receptive partner during anal sex.

"Men are douching for a clean butt, not to protect against STIs," said Crouch.

SFAF has purposefully refrained from using the word "clean," however, in the promotional materials for the campaign. As one panel in the Douchie butt health tips poster notes, "Poop happens," so "If you're having anal sex, poop might make an appearance. Roll with it and don't take it too seriously."

As Land explained, "If you don't douche that doesn't mean you are dirty."

And added Crouch, "A lot of people don't like to or don't want to douche. That is OK."

Positive reactionThe reaction to the campaign has been overwhelmingly positive, according to SFAF. A survey it conducted online last year resulted in 163 responses, with many men writing in detail to the agency regarding their experiences and advice for other men.

"Make sure you sit on the toilet long enough and get all the water out (you don't want your ass leaking with douche water, leaking with cum is fine ;) Stick a finger up there to make sure it's good after you're done," wrote one respondent.

Another advised, "Go easy until you find your individual tolerance level. Too much and too deep can produce unwanted side effects."

Other surveys done for the campaign have resulted in hundreds of replies. The campaign has been relatively cost effective for SFAF; apart from staff time, the agency has spent less than $200 on it. This summer alone, from July 19 through last Sunday, 83,924 people visited the webpages related to the campaign.

At the agency's Castro Street Fair booth Sunday, October 7, a bean bag toss game will feature Douchie as well as the promotional posters they have been appearing on since July prior to the Up Your Alley fair, the smaller, sister event to this weekend's larger Folsom Street Fair fetish festival.

In addition to douching, the campaign has allowed the agency to broach other topics related to anal health, from bleeding, cancer, and warts to tips on how to safely fist during sex and reduce the pain of anal intercourse. It also prompted Strut to revise its intake forms to ask about the anal health of its clients.